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Your Joint Pain is Personal and So is its Treatment.

Editor: Annlouise Ferguson

Are you one of the 43 million Americans suffering from arthritis?  Maybe you know one of the 600,000 Americans who had either a knee or a hip replacement this year.  Hip and knee replacement surgeon, Dr. Steven Myerthall, MD spoke to the Ahwatukee Foothills Rotary Club on Dec 1st about the causes, symptoms and treatment of joint pain. 

Dr. Myerthall drew laughter when he told the club about a patient complaining his leg hurt after running 23 miles.  His advice  was to  run 22 miles and stop.  There are cases where joint pain is caused by overuse and medical intervention can be prevented.

Joint pain is generally the result of osteo, rheumatoid  or post traumatic arthritis or avascular necrosis.  The most common cause is osteoarthritis.

Wear and tear on a joint causes osteoarthritis.  Dr. Myerthall explained while using slides of actual diagnostic cases to show the club what damage to a joint looks like at various stages.   Cartilage pitting causes roughness and irritation, leading to loss of cartilage and narrowing of the joint space.  With loss of cartilage, the patient experiences bone on bone.  The alignment of the bones at the joint is askew, not good.  Cysts can develop in the bone and spurs can grow on the edge of the bone.  The ends of the bones in the joint bleed and deteriorate.  Pain with osteoarthritis is more common in the evening after use. 

Rheumatoid arthritis is a chronic autoimmune disorder where the joint becomes damaged as well as the surrounding tissues.  Morning stiffness is most common with rheumatoid arthritis. Post Traumatic Arthritis occurs after a joint has been injured but the bone and cartilage did not heal properly, leaving the joint rough.  Avascular necrosis is a disease where the bone lacks blood supply so the bone deteriorates and dies.

When other medical intervention does not provide the needed relief, surgery may.  Possible surgical treatments, depending upon the joint involved, include arthroscopy, partial or total joint replacement, or resurfacing,

Early intervention with knee pain is best.  It allows for the use of a less invasive arthroscopic treatment.  The treatment is outpatient using 2-3 small incisions. 

When only one of the three regions of the knee, medial, lateral or patella, is damaged, a partial knee replacement, PKR, can be performed.  One in five knee replacements is a PKR.  Dr. Myerthall says his most satisfied patients are those who have undergone PKR. Usually because they have experienced less post operative pain, smaller incisions due to smaller implants used, and a shorter recovery time. 

When more than one area of the knee joint is compromised, a total knee replacement is recommended.  Dr. Myerthall reports his patients complain their knee does not feel the same afterward but the total replacement allows them to return to their previous activity level.

Dr. Myerthall noted that the major improvements to his practice have been minimally invasive surgery, computer assisted surgery and the Cormet Hip Resurfacing procedure.

Minimally invasive surgery, laparoscopic surgery, is done through small incisions. Using specialized techniques, miniature cameras with microscopes, tiny fiber-optic flashlights and high definition monitors, allows the surgeon to perform surgery through an incision that requires only a few stitches to close.  One example of minimally invasive hip surgery is the direct anterior hip replacement.

The direct anterior approach to hip replacement surgery allows the surgeon to reach the hip joint from the front of the hip as opposed to the side or back approach. This way, the hip can be replaced without detachment of muscle from the pelvis or femur during surgery. The surgeon can simply work through the natural interval between the muscles.  Dr Myerthall says the use of this approach can lead to a shorter hospital stay, smaller incision, less blood loss, less collateral damage to muscles, tendons and ligaments, less post operative restrictions and a quicker rehabilitation than a traditional hip replacement.

Dr Myerthall's use of a computer to map the patient's anatomy, properly size the implant and see the surgical site without having to use a ten or eleven inch  incision as in the past is a huge improvement.  Computer assisted surgery is a discipline where computer technology is applied to improve the outcome of orthopedic surgical procedures. 

The Cormet Hip Resurfacing procedure is an innovative process where the end of the thigh bone, femur, is capped with a metal covering using a strong cobalt chromium metal. This fits neatly into a metal cup that sits in the hip socket. The head swivels within the cup, gliding together to replicate the hip joint. The capping of the femur is comparable to capping a tooth.  The procedure conserves bone and allows for natural movement.  Dr. Myerthall is waiting for further action by the FDA as the procedure is approved in limited situations, usually for a young, healthy boned, active person.  

Despite the high and rising numbers of joints being replaced, Dr. Myerthall's policy is to schedule a joint replacement only when a patient asks to be scheduled.  This is when their pain is severe, interfering with daily activities and not responding to nonsurgical treatments. 

A patient undergoing a joint replacement can expect to return to the activities they enjoyed prior to replacement sans sky diving and downhill skiing.  Evidence of this expectation is Floyd Landis, the disqualified 2006 Tour de France winner, who returned to professional bicycling after having hip resurfacing surgery.

Steven Myerthall, MD is an internationally fellowship-trained specialist in minimally-invasive hip and knee reconstruction and arthroscopy, and is dedicated to exceptional patient care.  Recently he partnered with the Center for Orthopedic Research and Education in Arizona.  The CORE Institute offers comprehensive care for musculoskeletal health and wellness.  The doctor is the father of two young boys. 

The Cormet Hip Resurfacing System is manufactured by Corin and distributed exclusively by Stryker Orthopedics in the USA.

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